Individual
MRS. THEA A RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1036 PARK AVENUE EXT, CLEARFIELD, PA 16830-4028
(814) 765-9677
Mailing address
749 MAPLE ST, BROCKWAY, PA 15824-1405
(814) 661-3733
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
OS000518L
PA
Other
Enumeration date
05/11/2006
Last updated
07/26/2011
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